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A randomized controlled trial of prophylactic sublingual misoprostol versus intramuscular methyl-ergometrine versus intramuscular 15-methyl PGF2α in active management of third stage of labor

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Abstract

Objective

To compare the efficacy and side effects of 0.2 mg methyl-ergometrine IM, 400 μg misoprostol sublingual and 125 μg 15 methyl PGF2α IM in active management of third stage of labor.

Method

Two hundred low risk pregnant women with induced or spontaneous labor were randomized to receive either 400 μg misoprostol sublingually or 0.2 mg methyl-ergometrine intramuscularly or 125 μg 15-methyl PGF2α intramuscularly, after the delivery of anterior shoulder of baby. The main outcome measures were: blood loss more than 500 ml, need for additional oxytoxic drug, change in hemoglobin level and side effects due to drugs.

Results

The median estimated blood loss, blood loss more than 500 ml, need for additional oxytocic drug and change in hemoglobin levels were similar in all three groups. The significant side effects in the misoprostol group were shivering, pyrexia (temperature > 38°C) and vomiting, which were self-limiting. Diarrhea was significantly more in the 15 methyl PGF2α group. Three women in methyl-ergometrine group underwent manual removal of placenta. One woman in misoprostol group received blood transfusion.

Conclusion

Sublingual misoprostol appears to be as effective as intramuscular methyl-ergometrine and intramuscular 15-methyl PGF2α in the prevention of postpartum hemorrhage. It can be a good alternative in resource poor setting.

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Authors and Affiliations

  1. Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India

    Arvind Vaid, Vatsla Dadhwal, Suneeta Mittal, Deepika Deka, Renu Misra, Jai Bhagwan Sharma & N. Vimla

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  1. Arvind Vaid
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  2. Vatsla Dadhwal
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  3. Suneeta Mittal
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  4. Deepika Deka
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  5. Renu Misra
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  6. Jai Bhagwan Sharma
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  7. N. Vimla
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Correspondence to Vatsla Dadhwal.

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Vaid, A., Dadhwal, V., Mittal, S. et al. A randomized controlled trial of prophylactic sublingual misoprostol versus intramuscular methyl-ergometrine versus intramuscular 15-methyl PGF2α in active management of third stage of labor. Arch Gynecol Obstet 280, 893–897 (2009). https://doi.org/10.1007/s00404-009-1019-y

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  • DOI: https://doi.org/10.1007/s00404-009-1019-y

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